The Search for Strategies to Control Hypertension

Article see p 1183 Hypertension is a major contributor to the global disease burden.1 The worldwide prevalence of hypertension is estimated to be ≈26%, totaling ≈1 billion people. Because a larger proportion of the world's population is expected to be older in 2025, hypertension prevalence is projected to increase to ≥29% in the next 15 years.2 Currently, in the United States, approximately 73 million Americans have hypertension. Despite this “epidemic,” the US age-adjusted mortality rates for stroke and coronary heart disease decreased by 60% and 53%, respectively, between 1960 and 1994. Cardiovascular mortality has continued to decline since 1994, although at a less steep rate. It is likely that increased availability and utilization of effective antihypertensive agents have contributed to these favorable trends. In clinical trials of antihypertensive therapy, there has been a 35% to 40% reduction in stroke incidence, a 20% to 25% reduction in myocardial infarction, and a more than 50% reduction in the incidence of heart failure.3 Nevertheless, blood pressure remains uncontrolled in large numbers of people, even among those taking antihypertensive medications, and cardiovascular disease remains the most frequent cause of mortality.Based on National Health and Nutrition Examination Survey data, the age-adjusted hypertension prevalence in the United States has gradually increased over the past two decades (Table), possibly as a consequence of increasing obesity rates.4,5 From 1999 to 2000 and 2007 to 2008, hypertension awareness, treatment, and control rates have improved considerably, and it appears that the Healthy People 2010 goal of controlling blood pressure in 50% of all individuals with hypertension has been achieved. However, despite the availability of effective antihypertensive medications, the documented beneficial effect of lifestyle modifications, national guidelines for hypertension management, and the overwhelming evidence for the cardiovascular protective effect of hypertension control, blood pressure …